title: Tacrolimus rescue therapy in resistant or relapsing cases of primary glomerulonephritis.
abstract: BACKGROUND
  Patients with resistant or relapsing primary glomerulonephritis (PGN) after conventional immunosuppressive treatment have a worse renal outcome, and treatment of these patients remains problematic. In this study we aimed to determine the effect of tacrolimus in these patients.
  
  
  METHODS
  We prospectively studied 15 patients with PGN (3 membranous nephropathy, 6 membranoproliferative GN, 4 focal segmental glomerulosclerosis [FSGS], 1 IgA nephropathy and 1 IgM nephropathy) who were either resistant (n=7) or relapsing (n=8) after or during conventional immunosuppressive therapy. Tacrolimus was started at a dosage of 0.05 mg/kg per day. Prednisolone was either maintained or added to the tacrolimus regimen.
  
  
  RESULTS
  The mean duration of tacrolimus treatment was 28.9 +/- 2.4 months. Proteinuria decreased from 6.3 +/- 5.0 g/day to 0.5 +/- 0.6 g/day at the end of follow-up (p=0.001). Complete or partial remission was achieved by 60% and 40% of patients, respectively. Relapse occurred in only 2 patients with FSGS under tacrolimus treatment. There was no significant change in serum creatinine at the end of follow-up (from 1.4 +/- 1.0 mg/dL to 1.2 +/- 0.6 mg/dL, p=0.3). Serum albumin increased from 3.2 +/- 0.5 g/dL to 4.3 +/- 0.3 g/dL (p=0.0001). There were 6 relapses among 10 patients after the withdrawal of tacrolimus.
  
  
  CONCLUSIONS
  These data suggest that the combined therapy of tacrolimus and low-dose prednisolone may have a promising role to obtain long-term remission in resistant or relapsing PGN.
authors.affiliation: Division of Nephrology, Department of Medicine, Marmara Medical School, Istanbul - Turkey. ihakkiarikan@yahoo.com
authors.forename: Hakki
authors.initials: H
authors.lastname: Arikan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Koc
authors.forename: Fulya
authors.initials: F
authors.lastname: Cakalagaoglu
authors.forename: Zehra
authors.initials: Z
authors.lastname: Eren
authors.forename: Mark S
authors.initials: MS
authors.lastname: Segal
authors.forename: Serhan
authors.initials: S
authors.lastname: Tuglular
authors.forename: Cetin
authors.initials: C
authors.lastname: Ozener
authors.forename: Emel
authors.initials: E
authors.lastname: Akoglu
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria; D012008:Recurrence; D012074:Remission Induction; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus